Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
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Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation. / Willems, Stephan; Meyer, Christian; de Bono, Joseph; Brandes, Axel; Eckardt, Lars; Elvan, Arif; van Gelder, Isabelle; Goette, Andreas; Gulizia, Michele; Haegeli, Laurent; Heidbuchel, Hein; Haeusler, Karl Georg; Kautzner, Josef; Mont, Lluis; Ng, G Andre; Szumowski, Lukasz; Themistoclakis, Sakis; Wegscheider, Karl; Kirchhof, Paulus.
in: EUR HEART J, Jahrgang 40, Nr. 46, 07.12.2019, S. 3793-3799c.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Cabins, castles, and constant hearts: rhythm control therapy in patients with atrial fibrillation
AU - Willems, Stephan
AU - Meyer, Christian
AU - de Bono, Joseph
AU - Brandes, Axel
AU - Eckardt, Lars
AU - Elvan, Arif
AU - van Gelder, Isabelle
AU - Goette, Andreas
AU - Gulizia, Michele
AU - Haegeli, Laurent
AU - Heidbuchel, Hein
AU - Haeusler, Karl Georg
AU - Kautzner, Josef
AU - Mont, Lluis
AU - Ng, G Andre
AU - Szumowski, Lukasz
AU - Themistoclakis, Sakis
AU - Wegscheider, Karl
AU - Kirchhof, Paulus
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2019/12/7
Y1 - 2019/12/7
N2 - Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.
AB - Recent innovations have the potential to improve rhythm control therapy in patients with atrial fibrillation (AF). Controlled trials provide new evidence on the effectiveness and safety of rhythm control therapy, particularly in patients with AF and heart failure. This review summarizes evidence supporting the use of rhythm control therapy in patients with AF for different outcomes, discusses implications for indications, and highlights remaining clinical gaps in evidence. Rhythm control therapy improves symptoms and quality of life in patients with symptomatic AF and can be safely delivered in elderly patients with comorbidities (mean age 70 years, 3-7% complications at 1 year). Atrial fibrillation ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy, but recurrent AF remains common, highlighting the need for better patient selection (precision medicine). Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Atrial fibrillation ablation appears to improve left ventricular function in a subset of patients with AF and heart failure. Data on the prognostic effect of rhythm control therapy are heterogeneous without a clear signal for either benefit or harm. Rhythm control therapy has acceptable safety and improves quality of life in patients with symptomatic AF, including in elderly populations with stroke risk factors. There is a clinical need to better stratify patients for rhythm control therapy. Further studies are needed to determine whether rhythm control therapy, and particularly AF ablation, improves left ventricular function and reduces AF-related complications.
U2 - 10.1093/eurheartj/ehz782
DO - 10.1093/eurheartj/ehz782
M3 - SCORING: Journal article
C2 - 31755940
VL - 40
SP - 3793-3799c
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 46
ER -